Teacher Questionnaire for Summer Programs

This form is a required component for application to our summer programs. Thank you for assisting your student. Please allow 10 minutes to complete the form, as it must be completed in a single session.

Teacher Questionnaire

Student's Name*

Current Grade*

Teacher's Name*

Teacher's Title*

School Name*

School Address*

WRITING AND READING

Please rate the student on a scale of 1 to 5.

Overall writing skills*

1 below average

2

3 average

4

5 above average

Spelling*

1 below average

2

3 average

4

5 above average

Organization of ideas*

1 below average

2

3 average

4

5 above average

Vocabulary*

1 below average

2

3 average

4

5 above average

Student's overall reading skills*

1 below average

2

3 average

4

5 above average

Reading comprehension*

1 below average

2

3 average

4

5 above average

Reading fluency*

1 below average

2

3 average

4

5 above average

Word attack/decoding*

1 below average

2

3 average

4

5 above average

Student's current reading level*

This information is crucial for placement. Please do not leave blank.

Grade level equivalent*

This information is crucial for placement. Please do not leave blank.

Assessment used to determine reading level*

Date of Assessment*

MATH

Overall math skills

1 below average

2

3 average

4

5 above average

Computational skills

1 below average

2

3 average

4

5 above average

Understanding of new concepts

1 below average

2

3 average

4

5 above average

Problem-solving skills

1 below average

2

3 average

4

5 above average

PERSONAL QUALITIES

Enthusiasm*

1 below average

2

3 average

4

5 above average

Leadership*

1 below average

2

3 average

4

5 above average

Sense of humor*

1 below average

2

3 average

4

5 above average

Emotional stability*

1 below average

2

3 average

4

5 above average

Concern for others*

1 below average

2

3 average

4

5 above average

Student's overall class performance*

1 below average

2

3 average

4

5 above average

Does the student have any attentional difficulties?*

yes

no

Does the student seem anxious?*

yes

no

Is the student often absent?*

yes

no

What are this student's strengths?*

What are this student's weaknesses?*

Does the student receive any support services?*

What adjectives or phrases would you use to describe the student?*

Is there anything else you would like us to know?

Thank you for taking the time to assist us! If you would like more information about our programs or job openings, please contact us at info@ritutorial.org or 401-723-4459.